本文關(guān)鍵詞： 單肺通氣 肺損傷 肺保護(hù)右美托咪定 地塞米松 麻醉　出處：《重慶醫(yī)學(xué)》2015年34期 　論文類型：期刊論文

【摘要】：目的研究右美托咪定聯(lián)合地塞米松對單肺通氣(OLV)手術(shù)患者的肺保護(hù)作用。方法選取2010年8月至2014年9月在該院行食管癌根治術(shù)患者96例,隨機(jī)分為對照組、右美托咪定組(DEX組)和右美托咪定加地塞米松組(聯(lián)合組),每組32例。3組患者均采用全憑靜脈麻醉,術(shù)中行OLV,于麻醉誘導(dǎo)前5min(T0)、OLV 30min(T1)、OLV 60min(T2)、OLV 90min(T3)、OLV 120min(T4)、恢復(fù)雙肺通氣(TLV)30 min(T5)檢測3組患者血清中的白介素IL-1β、IL-10以及腫瘤壞死因子α(TNF-α)水平變化。比較各組患者術(shù)中肺臟組織標(biāo)本勻漿中戊二醛(MDA)、髓過氧化物酶(MPO)、黃嘌呤氧化酶(XOD)水平變化,并記錄3組患者機(jī)械通氣時(shí)間、OLV時(shí)間、手術(shù)時(shí)間、總失血量、總輸液量、術(shù)后感染率和住院天數(shù)。結(jié)果 OLV后各組患者血清IL-1β、IL-10、TNF-α均呈顯著升高趨勢(P0.05),60min后DEX組、聯(lián)合組血清IL-1β、TNF-α均低于對照組,90min后DEX組、聯(lián)合組血清IL-10水平顯著高于對照組(P0.05),與DEX組比較,聯(lián)合組在T3后顯著高于DEX組(P0.05);與對照組比較,DEX組、聯(lián)合組肺組織勻漿中MDA、MPO、XOD水平均顯著低于對照組(P0.05);與DEX組比較,聯(lián)合組在T3后顯著低于DEX組(P0.05)。對照組術(shù)后出現(xiàn)3例肺感染,DEX組有1例感染,而聯(lián)合組未出現(xiàn)術(shù)后感染病例。對照組平均住院天數(shù)最長(16d),DEX組比對照組短2d,而聯(lián)合組平均住院天數(shù)比DEX組短1d,雖然差異無統(tǒng)計(jì)學(xué)意義,但具有很好臨床意義。結(jié)論右美托咪定用于全身麻醉OLV術(shù)中具有肺保護(hù)作用,而右美托咪定聯(lián)合地塞米松在OLV對單肺通氣手術(shù)患者具有更好的肺保護(hù)作用,可使肺組織炎癥和氧化應(yīng)激反應(yīng)程度都顯著降低。
[Abstract]:Objective to study the effects of dexmetidine combined with dexamethasone on single lung ventilation (OLVV). Methods 96 patients with esophageal cancer underwent radical resection from August 2010 to September 2014. They were randomly divided into control group, dexmetidine group (DEX group) and dexamethasone plus dexamethasone group (Dexamethasone group). 32 patients in each group were treated with total intravenous anesthesia. OLV was performed during the operation. Before anesthesia induction, OLV 30 mins T1 + OLV 60 min T2 + OLV 90 min T3). The serum levels of interleukin IL-1 尾 in the three groups were detected by OLV 120 min, T4 and T5. The levels of IL-10 and TNF- 偽 were compared in the lung tissue homogenate of each group during operation, and the contents of malondialdehyde (MDA) and myeloperoxidase (MPO) in the homogenate of lung tissue were compared. The changes of XODs in xanthine oxidase were recorded, and the time of mechanical ventilation and OLV, operation time, total blood loss and total infusion volume were recorded in the three groups. Results after OLV, the serum IL-1 尾 -IL-10 TNF- 偽 increased significantly in the DEX group. The level of serum IL-1 尾 -TNF- 偽 in the combined group was significantly higher than that in the control group (P 0.05), compared with that in the DEX group. After T3, the combined group was significantly higher than the DEX group (P 0.05). Compared with the control group, the level of MDA-MPOOX XOD in the lung homogenate of the combined group was significantly lower than that in the control group (P 0.05). Compared with DEX group, the combined group was significantly lower than that of DEX group after T3 (P 0.05). In the control group, there were 3 cases of pulmonary infection and 1 case of infection in DEX group after operation. The average hospitalization days in the control group were 2 days shorter than those in the control group, while the average hospitalization days in the combined group were 1 day shorter than that in the DEX group. Although the difference is not statistically significant, it has good clinical significance. Conclusion dexmetomidine has lung protection effect in general anesthesia OLV. Dexamethasone combined with dexamethasone has a better lung protective effect on patients undergoing single lung ventilation and can significantly reduce the degree of inflammation and oxidative stress in lung tissue.
【作者單位】： 中國人民解放軍第175醫(yī)院麻醉科;
【分類號】：R614
【正文快照】： 單肺通氣(one lung ventilation,OLV)技術(shù)可使手術(shù)側(cè)肺萎縮,有利于明確病變范圍,為開胸手術(shù)創(chuàng)造了良好條件。目前,已廣泛應(yīng)用于胸部外科手術(shù),如食管癌、肺膿腫、肺葉切除、全肺切除、胸主動脈瘤等。然而,OLV可以引起一系列的病理、生理改變,如肺萎縮(復(fù)張)、肺內(nèi)分流率(Qs/Qt)

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本文編號：1444856